Hearing is complex, requiring a series of actions and reactions to work. The process involves many parts of the ear working together to convert sound waves into information the brain understands and interprets as sounds.

  1. Sound waves enter the ear canal and travel toward our eardrums.
  2. These sound waves cause the eardrum and bones in the middle ear to vibrate.
  3. Tiny hair cells inside cochlea (inner ear) convert these vibrations into electric impulses/signals that are picked up by the auditory nerve.
  4. At birth, each normal ear has about 12,000 sensory cells, called hair cells, which sit on a membrane that vibrates in response to incoming sound. Each frequency of a complex sound maximally vibrates the membrane at one location.

    Because of this mechanism, we hear different pitches within the sound. A louder sound increases the amplitude of the vibration, so we hear loudness.
  5. Signals sent to the brain from auditory nerve are then interpreted as sounds.

Hearing Health Foundation advises all who believe they may have hearing loss, tinnitus, and/or balance concerns to make an appointment with a hearing health professional, such as an audiologist or an ear, nose, and throat specialist (ENT).

A comprehensive evaluation will determine the types and severity of hearing loss present and assist hearing health professionals in making appropriate recommendations for hearing aids, cochlear implants, and other assistive devices.

There are five types of hearing loss:

  1. Conductive: Sound waves are not able to efficiently go through the outer ear canal to the eardrum and the small bones of the middle ear. There is typically a reduction in sound levels or the ability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically.
  2. Sensorineural: Caused by damage to the hairs within the cochlea in the inner ear; sound not able to be converted into electrical signals for the auditory nerve. Treatments include amplification through hearing aids or cochlear implants.
  3. Combined (or mixed) Hearing Loss: Combination of both conductive and sensorineural hearing loss. The conductive component at times may be treated and reversed medically or surgically. However, the sensorineural component is often permanent. Hearing aids can be beneficial for persons with a mixed hearing loss. At the same time, caution must be exercised by the hearing care professional and patient if the conductive hearing loss is due to ear infections.
  4. Neural: Neural hearing loss is rare and is the result of damage or malformation to the auditory nerve that connects the cochlea to the brain. The hearing loss is usually profound and permanent. Traditional hearing treatment options like hearing aids or cochlear implants are not viable because the auditory nerve is not able to transmit information to the brain. In some cases, auditory brainstem implants have been utilized.
  5. Auditory Neuropathy: In this rare type of hearing loss, sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impaired. Those with auditory neuropathy, regardless of an underlying hearing loss, have trouble with speech-perception or understanding speech clearly.


Degrees of hearing loss refer to the severity of the loss and are generally described as mild, moderate, severe, or profound. Hearing loss that borders between two categories is typically labeled as a combination of the two categories (for example, thresholds at 60 dB HL might be called moderate-to-severe).

People with a mild hearing loss may have difficulty hearing soft spoken people and young children. They are often able to hear the loud or more intense vowel sounds, but may miss some of the softer consonant sounds. They may have to ask people to speak up or repeat themselves on occasion.

In addition to missing consonant sounds, vowel sounds then become more difficult to hear. People with a moderate hearing loss often comment that without hearing aids they hear, but can’t always understand.

Without hearing aids, speech is inaudible. Even with hearing aids, speech may be difficult to understand. Increasing the amplification doesn’t always make it clearer.

Without hearing aids or cochlear implants, speech is inaudible.

Without hearing aids, may be unable to hear very loud sounds like airplane engines, traffic, or fire alarms.


Source: Cochlear

  • Age-Related Hearing Loss (ARHL): Loss of hearing as a result of aging. This condition is known as presbycusis (prez-buh-KYOO-sis). Many people with ARHL, or any other type of hearing loss, also have a ringing, hissing, or roaring sound in the ears, called tinnitus (tin-NY-tus).
  • Noise-Induced Hearing Loss (NIHL): Occurs as a result of exposure to too much loud noise. Many construction workers, farmers, musicians, airport workers, and military personnel have NIHL. Temporary tinnitus after loud noise is a warning sign that repeated exposure may cause permanent NIHL.
  • Genetic factors: More than half of congenital hearing loss cases, or hearing loss present at birth, are due to genetic factors and can be caused by recessive or dominant genes. Examples of heredity hearing loss include:
    • Connexin 26 disorder is the most common cause of congenital nonsyndromic hearing loss. This complex genetic condition leads to faulty copies of the GJB2 gene.
    • Otosclerosis is an inherited disease of the middle ear that causes hearing loss due to the ear’s inability to amplify sound.
    • Usher syndrome, combined deafness and blindness, can appear as one of three different types.
    • Waardenburg syndrome is an inherited disorder often characterized by varying degrees of hearing loss and changes in skin and hair pigmentation.
  • Head trauma can directly injure any part of the ear, and can cause fluid leakage from the inner ear into the middle ear, known as perilymph fistula.
  • Ototoxic medications.
  • Tumors, such as acoustic neuroma.
  • Viral or bacterial infections, such as ear infections.
  • Impacted earwax.

Hearing loss is rarely sudden or total, unless you are exposed to an exceptionally loud noise or head trauma. It’s usually gradual—sometimes so gradual that your family and friends may notice the problem before you do.

Here are 10 questions to help determine whether you (or a loved one) should have your hearing tested:

  1. Do you have difficulty hearing over the telephone?
  2. Do you have trouble following the conversation when two or more people are talking at the same time?
  3. Do people complain that you turn the TV volume up too high?
  4. Do you have to strain to understand conversation?
  5. Do you have trouble hearing in a noisy background?
  6. Do you find yourself asking people to repeat themselves?
  7. Do the people you talk to seem to mumble or speak unclearly?
  8. Do you misunderstand what others are saying frequently?
  9. Do you have trouble understanding soft speech or voices?
  10. Are people frequently annoyed due to your misunderstanding of what was said?

If you answered “yes” to three or more of these questions, you may want to schedule a professional hearing evaluation with a hearing healthcare professional.

The material on this page is for general information only and is not intended for diagnostic or treatment purposes. A doctor or other healthcare professional must be consulted for diagnostic information and advice regarding treatment.


Hearing loss affects only older adults.


There are an estimated 48 million people with hearing loss in at least one ear in the U.S., and about two-thirds are under 65 years old. A 2010 Journal of the American Medical Association study examining a comprehensive data set of the U.S. population found that 1 in 5 children ages 12 to 19 showed some sign of hearing loss in one or both ears.

The World Health Organization has warned that 1.1 billion teenagers and young adults are at risk of hearing loss “due to the unsafe use of personal audio devices, including smartphones, and exposure to damaging levels of sound at noisy entertainment venues such as nightclubs, bars, and sporting events.”


Hearing loss doesn’t affect the rest of my health.


Hearing loss has been associated with cognitive decline, dementia, falls, social isolation, and depression.

It’s theorized that the “cognitive load” on the brain may take away resources the brain uses for other functions—such as short-term memory. Researchers are now studying whether treating the hearing loss, such as with hearing aids, can reverse or even prevent some of these conditions. A 2015 French study examining population-based data spanning 25 years found that hearing aid use “attenuated” (reduced) hearing loss–associated cognitive decline.


Hearing aids are like glasses.


When one puts on a pair of glasses, vision instantly can be corrected to 20/20. This is not true of hearing, as a brain needs time to adjust to the sound coming through the hearing aid. Because of each person’s unique audiogram, with differences in abilities to hear various frequencies, the hearing aid needs to be programmed to the patient’s hearing ability, and the fine-tuning may take repeated trips to the audiologist or hearing healthcare provider.

Even the most advanced hearing aids will not restore hearing 100 percent, and may need auditory training to help a brain process sounds. There is no vision training to wear glasses.


Hearing loss is inevitable, especially with age, and can’t be prevented


Hearing loss has many causes, including genetics, certain medications, and exposure to loud noises. Smoking and diabetes can also lead to hearing impairment.

Despite its prevalence among seniors, there is some debate as to whether hearing loss is an inevitable outcome of aging. “Auditory acuity appears to be preserved in quiet, primitive societies,” says Daniel Fink, M.D., who cites studies of the Mabaan population in the Sudan, published in 1962, and one of Easter Island in 1983. Like skin damage from sun exposure, the cumulative effect of today’s loud societies has led to a greater incidence of hearing loss that becomes increasingly apparent over a lifetime—that is, in older adults. Noise exposure is the most preventable cause of hearing loss.


I don’t need hearing aids since my hearing is mostly fine.


When you have a hearing loss in some frequencies and not others, it is easier to dismiss it as unimportant. Even a mild hearing loss can adversely affect your cognitive capabilities, work, home, and social life. Fortunately, the brain’s neuroplasticity means that treating hearing loss allows the brain to relearn how to hear. Proper hearing aid use correlates with improved outlook, mood, mobility, independence, communication, and social interaction.

Some of this content originally appeared in Hearing Health magazine’s Spring 2016 issue.

9 Do’s & Don’ts When Talking to a Person with Hearing Loss

Hearing loss is invisible. When people aren’t aware of your hearing loss, they may make assumptions and be less willing to make accommodations. Even so, Hearing Health Foundation supporter John Cech has found that even when someone is aware of his hearing loss, they can still become impatient and frustrated trying to communicate.

Read John’s tips below, which originally appeared in Hearing Health magazine’s Spring 2016 issue. Have tips you want to share? Email us at info@hhf.org!


Do Face me and make eye contact. Reading your lips helps me fill in missing pieces of conversations.

Don’t Mumble or talk softly, especially in a noisy environment. I can hear you talking, but the background noise makes deciphering what you are saying very difficult.


Do Schedule meetings with fewer people in smaller, quieter quarters with good lighting.

Don’t Put me in a position that will make hearing difficult, like conference calls or group meetings in large rooms with people spread out.


Do Drop me a text message or email for important information. Take advantage of voice recognition to dictate the message if typing it is too time-consuming.

Don’t Expect me to hear you clearly on a cell phone. The microphones pick up too much ambient sound.


Do Try a different word if I still don’t understand what you are referring to. Or repeat the whole sentence.

Don’t Repeat only the word I say I didn’t catch.


Do Ask me what I didn’t understand, and try saying it another way.

Don’t Say “never mind” or “it isn’t important.” If it was important enough to try to talk to me about something, don’t give up in frustration.


Do Position yourself next to the person I am talking to in order to help restate what they are saying. Stand so that I can see your face so I can speech-read if needed.

Don’t Avoid me or talk behind my back to people, telling them I don’t hear. I do hear. I just don’t understand clearly, and I am aware of being dismissed.


Do Help re-explain what was asked of me if I answer incorrectly.

Don’t Apologize for me to others. I can do that myself.


Do Speak slowly but naturally. No need to shout.

Don’t Look away with a frustrated or disgusted look. My disability is difficult enough for me. I don’t need it to be reinforced by people’s negative reaction to it.


Do Smile. Look at me with understanding, not pity.

Don’t Talk to me in short, single-syllable words, like to a child. Thank you.

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